Residual aneurysm is seen in 1-10% of aneurysms clipped. Perfect reconstruction tends to be better for MCA rather than ACOM artery aneurysms, whilst basilar tip aneurysms are notoriously difficult to completely obliterate, particularly if they are pointing posteriorly. Giant aneurysms, those with a wide neck or with calcifications within the wall are often difficult to clip completely and remnants or compromised vessels are common. Giant aneurysms are completely occluded in only 60% of cases compared with 85 and 93% in aneurysms measuring greater than 10 mm and less than 10 mm, respectively.
Complete occlusion of the aneurysm is important, as there is a small but definite chance of aneurysmal regrowth from the unprotected remnant, although, occasionally, this undergoes thrombosis. The management of residual aneurysmal necks differs between units. Some surgeons recommend immediate re-operation to allow complete occlusion, whilst others prefer to watch the remnant with repeat DSA to document any change in size. The risk of hemorrhage from incompletely occluded necks is less than 0.5-1% per year at an average of 10.5 years.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.